Information Services Division

• Rates of stillbirths and deaths: Lowest ever recorded stillbirth rate in Scotland
  The rates of stillbirths, neonatal deaths and infant deaths (all deaths in the first year) were the lowest ever recorded in Scotland as was the perinatal mortality rate (stillbirths plus deaths in the first week of life). The rate of post-neonatal deaths equalled the lowest ever recorded.
  Stillbirth rate 4.9 per 1000 births
  Neonatal death rate 2.6 per 1000 live births
  Perinatal mortality rate 6.9 per 1000 births
  Post-neonatal deaths 1.2 per 1000 live births
  Infant mortality rate 3.7 per 1000 live births
• Total births and deaths in 2010: There were 59,082 births, 281 fewer than in 2009, reversing the steady rise since 2002. A total of 661 deaths were notified to the SSBIDS, comprising 152 late fetal deaths, 291 stillbirths, 150 neonatal deaths and 68 post-neonatal deaths.
• Causes of stillbirths and neonatal deaths: The most frequent identifiable causes of stillbirth were antepartum haemorrhage (bleeding in pregnancy) and congenital abnormality of the baby but 62% had no obvious explanation. Examination of the placenta, however, showed an abnormality in 62% of these “unexplained” stillbirths and 29% of these babies had evidence of poor growth in the womb.
  Prematurity was the most common problem associated with neonatal deaths, accounting for 33% while congenital abnormality caused 23% of neonatal deaths.
• Other findings:
  The postmortem rate for stillbirths rose to 63% from 59% in 2009.
  The placenta was examined histologically in 80% of stillbirths.
  There is an association between obesity and stillbirth and between infant death and smoking and deprivation.
  Antenatal screening reduces the rates of neural tube defects and Down's syndrome at birth.
• NHS Board variations: Variations in the rates of stillbirths and neonatal deaths between NHS Boards are likely to be related to random variation and to differing registration practices. Possible additional reasons for an increased stillbirth rate in one board area are being investigated.
• Commentary: Commentary is provided on some of the factors which may have contributed to a fall in all death rates. Further improvements to neonatal death registration, data collection, death classification and reporting are also discussed and form the basis of some of the recommendations.

• In 2010 the overall use of systemic antibacterials in primary care was 1.9% lower than in 2009 when expressed as number of items per 1000 population per day, equivalent to 53,000 fewer prescriptions. Reductions in the use of broad spectrum antibacterials known to increase the risk of Clostridium difficile infection (CDI) (expressed as items/1000/day) were observed from 2008 to 2010. Reductions within specific groups are as follows: cephalosporins 46.7%; combination penicillins (mainly co-amoxiclav) 36.7%; fluoroquinolones 26.3%. These changes are equivalent to 311,000 fewer prescriptions for high risk antibacterials since 2008.
• Information from the Hospital Medicines Utilisation Database (HMUD) from hospitals in 10 NHS boards (covering 58% of the Scottish population) shows the use (expressed as DDD/1000/day) of antibacterials associated with high risk of CDI in 2010 was 30.7% lower than in 2008. Reductions were observed in all four groups of high risk antibacterials: cephalosporins 54%; co-amoxiclav 27%; fluoroquinolones 26%; clindamycin 13%.
• Antimicrobial resistance among Gram-negative bacteraemias showed, with one exception, stable or decreasing trends in the period 2008-2010. This compares favourably to the situation in Europe. In particular the stable or decreasing trend in cephalosporin resistance in E. coli and K. pneumoniae is remarkable. In more than half of European countries increases in cephalosporin resistance were reported in the same period.
• An exception to the positive development is the increasing gentamicin resistance in E. coli (from 7.3% to 9.2% from 2008 to 2010). Gentamicin is increasingly used in hospitals as cephalosporin use has been restricted in order to contain CDI.
• Emergence of carbapenem resistance is also a matter of concern. One percent of the Scottish K. pneumoniae bacteraemia isolates were resistant to carbapenems in 2010. Increasing numbers of carbapenemase producers have been reported since 2008.
• These findings suggest that SAPG in collaboration with AMTs is having a continued positive impact on the quantity and quality of prescribing in primary and secondary care and helping to contain the emergence of resistance. CDI rates have decreased 65% in the period 2008-2010 which coincides with reduction in use of high risk antimicrobials in both primary and secondary care. There is still room for improvement though; more detailed examination of antimicrobial use in primary care showed that older people who are most at risk for CDI are more likely to be prescribed a high risk antimicrobial and the threat of emerging resistance remains as shown by the rise in gentamicin resistance.

Allergic conditions
There were around 10,000 hospital episodes due to allergic conditions in Scotland in 2010/11, of which around 8,000 were due to asthma.

There were small numbers of admissions for some individual allergic conditions, which means that trends should be interpreted with caution. However in the seven years up to 2010/11 there were rises in the number of admissions and the number of people being admitted for allergic conditions in general, including anaphylaxis.

The number of admissions for asthma shows wide variations from year to year, but between 2004/05 and 2010/11 there was a moderate fall in the number of people admitted at least once during a year, from 11 to 9 per 100,000 per year. The fall in asthma admissions was more marked for asthma diagnosed as ‘predominantly allergic’.

Smoking

• Among 13 year olds, 3% of both boys and girls were regular smokers . Among 15 year olds, 13% were regular smokers: 11% of boys and 14% of girls.
• Since peaks in 1996 and 1998, the prevalence of regular smoking has substantially reduced over recent years. Among both 13 year olds and 15 year olds, levels are now the lowest they have been since the survey began in 1982.

Drinking

• Forty-four per cent of 13 year olds and 77% of 15 year olds have ever had an alcoholic drink. Fourteen per cent of 13 year olds and 34% of 15 year olds reported consuming alcohol in the last week.
• There was a decrease in the proportion of 13 year olds who had ever had an alcoholic drink: from 52% in 2008 to 44% in 2010. This was also the case, although to a lesser degree, for 15 year olds (82% in 2008 compared with 77% in 2010).
• There was a increase in the proportion of pupils who had drunk in the last week: from 11% in 2008 to 14% in 2010 among 13 year olds and from 31% in 2008 to 34% in 2010 among 15 year olds.

Drug Use

• Twenty-one per cent of 15 year olds and 5% of 13 year olds reported that they had ever used drugs. 19% per cent of 15 year olds and 4% of 13 year olds reported they had used drugs in the last year and 11% of 15 year olds and 3% of 13 year olds reported that they had used drugs in the last month.
• While between 2004 and 2006 there was a substantial decrease in the prevalence of drug use in the last month, between 2006 and 2008 prevalence decreased only among 13 year old boys. Since 2008, prevalence has decreased further only among girls: among 15 year old girls, the decline has been from 11% in 2008 to 9% in 2010 and among 13 year old girls the decrease has been from 3% in 2008 to 2% in 2010.

Whereas life expectancy (LE) is an estimate of how many years a person might be expected to live, healthy life expectancy (HLE) is an estimate of how many years they might live in a ‘healthy’ state. HLE is a key summary measure of a population's health.

• The most recent annual estimates for Scotland are for boys born in 2010 to live 76.3 years on average, 59.5 of these in a ‘healthy’ state. Girls born in 2010 would be expected to live 80.7 years on average, 61.9 of these years being ‘healthy’.
• Underlying trends in both LE and HLE at birth show a general improvement in Scotland over recent years.
• There is a major discontinuity in the HLE series between 2008 and 2009 due to a change in methodology to align with the European Union. This results in estimates of HLE at birth from 2009 onwards being over 8 years lower for each sex. These new estimates form the start of a new time trend for future years.
• The gap between LE and HLE (the years expected to be spent in a ‘not healthy’ state during the average lifetime) has been fairly constant for females between 1980 and 2008, but tended to increase for males.
• There are considerable variations in LE and HLE at birth in Scotland between males and females and among different geographical and socio-economic groupings.
• For example, in 2009-10, male LE at birth ranged from 81.0 years in the least deprived quintile to 70.1 years in the most deprived quintile (a difference of 10.9 years). For male HLE at birth, the figures were 68.5 and 50.0 years respectively (a difference of 18.5 years). For females, LE at birth ranged from 84.2 years in the least deprived quintile to 76.8 years in the most deprived quintile (a difference of 7.4 years) while for HLE at birth, the figures were 70.5 and 52.5 years respectively (a difference of 18.0 years).
• LE and HLE both tend to be worse (lower) in Scotland than in the UK as a whole.
• Scotland has one of the lowest Les in Western Europe. International comparisons of HLE are hampered by the lack of consistent health measures. However, on the basis of a related indicator, disability-free life expectancy, Scotland would appear to compare poorly with many Western European countries, particularly for males.

• There was a total of 760 deaths due to suicide and events of undetermined intent in 2009. Of these, 744 were Scottish residents.
• Almost three-quarters of those who died were male and almost half aged between 35 and 54 years.
• Among those of employment age, 68% were in employment and a wide range of occupations were represented.
• Seventy one percent of suicidal acts occurred in a private dwelling.
• Sixteen percent of those completing suicide died in hospital.
• Of the Scottish residents, 441 (59%) had been an inpatient in a general hospital less than five years before death.
• Of these 441 inpatients, 26% had a diagnosis of ‘Injury from Intentional Self Harm’ and 20% had a diagnosis of ‘Unintentional Injury (including assault by another person)’, at discharge.
• Twenty one percent had been a psychiatric inpatient less than five years before death.
• Mood disorders, substance misuse and schizophrenia were the most frequent diagnoses at discharge from a psychiatric unit.

It is important to note that hospital admissions data for NHS Scotland for 2010/11 are estimated to be only 95% complete. NHS Grampian and NHS Lanarkshire hospital admissions data are estimated to be 64% and 84% complete respectively. This is mainly due to the implementation of a new IT Patient Management System which has resulted in data submission backlogs from November 2010 for both Boards. For these reasons, hospital admissions data for Scotland, NHS Grampian and NHS Lanarkshire for 2010/11 should NOT be directly compared with data for other years.

All hospital admissions data presented for 2010/11 are based on the data submissions which have been received by ISD Scotland to date and do not include any element of estimation or imputation.

It is possible to directly compare 2010 deaths as a result of an unintentional injury with previous years.

• In 2010/11, unintentional injuries accounted for approximately 1 in 7 emergency hospital admissions for children and 1 in 9 for adults.
• In 2010/11, there were over 354,000 patients admitted to hospital as an emergency. Around 15% of these were admitted as a result of an unintentional injury during the year.
• The number of emergency admissions to hospital, due to unintentional injuries, was 58,307 in 2010/11. Although the data are incomplete for 2010/11, it is anticipated that the recent downward trend in the number of emergency admissions is continuing.
• In 2010/11, there were over 32,000 emergency admissions to hospital due to falls. This represents 55% of the total number of emergency admissions to hospital due to unintentional injuries.
• In 2010, there were 1,364 deaths as a result of an unintentional injury, compared with a similar figure of 1,367 in 2006.
• In 2010 approximately 1 in 19 childhood deaths are due to an unintentional injury. In adults, deaths due to an unintentional injury account for approximately 1 in 40 deaths.
• Between 2006 and 2010, adults and children in the most deprived areas were approximately twice as likely to die as a result of an unintentional injury compared to those people from the least deprived areas.

• There were around 354,000 acute inpatient and day case discharges in the quarter ending September 2011. This is a slight decrease of 0.5% when compared to the same quarter of the previous year but is comparable with the average number of acute inpatient and day case discharges over the last 10 quarters.
• The total number of outpatient attendances in the quarter ending September 2011 was around 1,159,000. This is an increase of around 0.9% on the quarter ending September 2010.
• The average number of available staffed beds in acute specialties was recorded as 16,353 in quarter ending September 2011 and was 16,624 in the quarter ending September 2010.
• There has been a decrease of 2.7% in the emergency bed day rate per 1,000 population for patients aged 75+ from 5,530 to 5,383 between 2008/09 and 2009/10. Scotland level data for 2010/11 is not yet available.

It should be noted that outpatient, inpatient and day case figures may include an element of estimation for any incomplete or missing data submissions. Therefore, data for the latest time periods should be treated as provisional.

• 96.7% of patients started treatment within 62 days of urgent referral with suspicion of cancer; an increase of 1.1 percentage points compared to the period April - June 2011. Within the same period, 97.9% of patients started treatment within 31 days of decision to treat (regardless of the route of referral); an increase of 0.4 percentage points compared to the period April - June 2011. The target, for both the 31-day and 62-day, set by the Scottish Government is 95% by October – December 2011.
• For all cancer types combined, NHS Borders reported that 98.6% of patients started treatment within 62 days, the highest of the mainland NHS Boards in Scotland. The lowest proportion of patients that started treatment within 62 days was found in NHS Grampian, with 91.3%. Aside from Island Boards and the Golden Jubilee, the highest proportion of patients that started treatment within 31 days was found in NHS Borders and NHS Ayrshire & Arran, with 100%; the lowest proportion was found in NHS Forth Valley, with 95%.
• The highest proportion of patients that started treatment within 62 days of urgent referral with suspicion of cancer were screened positive breast cancer patients, with 99.6%; the lowest proportion of were non-screened cervical patients, with 84.6%. The highest proportion of patients that started treatment within 31 days of date decision to treat were screened positive cervical and lymphoma patients with 100%; the lowest proportion were urology patients, with 94.3%.
• The highest maximum wait from urgent referral with suspicion of cancer to treatment was 145 days; this occurred in NHS Grampian. The highest maximum wait in days relating to the 31 day target occurred in NHS Lothian, with a wait of 112 days.
• 3.7% of the 62-day target cohort and 2.3% of the 31-day target cohort were excluded from the performance calculations due to clinical reasons, or the patient died before treatment or refused all treatment. Waiting times adjustments have been applied to both sets of statistics to take into account periods of patient unavailability and medical suspensions. Within Scotland, there were 460 occurrences of patient unavailability and 506 occurrences of medical suspension within the 62-day target cohort. Corresponding figures for the 31-day target cohort were 267 occurrences of patient unavailability and 247 occurrences of medical suspensions.

• There has been a steady increase in the headcount of GPs contracted to work in Scottish practices since the introduction of the General Medical Services contract in 2004, rising from 4,456 in 2004 to 4,937 in 2011 (an increase of 10.8%).
• In the same time period there has been a large rise in the number of salaried GP posts, from 188 in 2004 to 533 in 2011 (an increase of 184%).

• There were around 20,919 inpatient admissions to mental health hospitals during the year ending 31 March 2011. This continues the downward trend seen in recent years and represents a 17% fall in the number of admissions since year 2006/07.
• In 2010/11 around 55% of all inpatient mental health admissions were re-admissions. This percentage is similar to those of the previous five years.
• The number of patients who had a psychiatric readmission within one year of a previous psychiatric admission has decreased steadily from 4,576 for the year ending 31December 2004 to 3,426 for the year ending 31 December 2009. The year on year reduction from the baseline figure at December 2004 was 8.4% at December 2005, 13.8% at December 2006, 17.8% at December 2007 and 25.1% at December 2009. It should be noted that due to completeness issues data for the year ending 31 December 2008 are unavailable.
• Alcohol/drug related problems accounted for 25% of all discharge diagnoses in men and schizophrenia accounted for a further 19%. For women, mood (affective) disorders accounted for 32% of the diagnoses recorded, while dementia diagnoses were identified in 14% of discharges.
• In 2010/11, around 65% of all mental health discharges had a hospital length of stay of 4 weeks or less. This is similar to previous years.

• In July - September 2011, of the 10,718 drug and/or alcohol clients who started their first treatment 84% had waited 3 weeks or less. This represents an increase of approximately 1% on the previous quarter.
• Approximately 87% of the 7,088 clients who started alcohol treatment between July and September 2011 had waited 3 weeks or less. This represents an increase of approximately 2% on the previous quarter.
• Approximately 80% of the 3,630 clients who attended an appointment for drug treatment waited 3 weeks or less. This is inline with the percentage for the previous quarter.
• Of those who were still waiting to start drug or alcohol treatment (3,963 clients), approximately 10% had waited more than 6 weeks at the end of September 2011. This is inline with the percentage for the previous quarter.

• The gross total payments to Scottish dispensing contractors continue to increase year on year.
• The net ingredient cost (NIC) paid to dispensing contractors for drug reimbursement continues to increase, from £478 million in the first 6 months of 2010/11 to £490 million in the first 6 months of 2011/12. However, the cost for remuneration of services shows a decrease by about £2.2 million (2.2%) from £102.5 million in the first 6 months of 2010/11 to £100.3 million in the first 6 months of 2011/12.
• The gross ingredient cost (GIC) paid to dispensing contractors for the first 6 months of 2011/12, in respect of dispensing was £509 million. This is an increase of just under £2 million (0.4%) when compared to the first 6 months of 2010/11.
• The number of prescription items for the first 6 months of 2011/12 was 47.1 million. This is an increase of just under 1.5 million (3.2%) compared to the first 6 months of 2010/11.
• The cost of a single prescription was reduced from £3.00 to £0.00 in April 2011.